- 10YO Heeler X FS wt =30#
- Chronic diarrhea (suspected small intestinal) since at least January 2015. Weight loss of 4lbs in that time. Pet is also hypoalbuminemic.
- Sonographically normal liver, adrenals and kidneys.
- CBC-WNL, U/A: NSFs, Chem Panel- All WNL except: Albumin 2.2 (2.7-4.4) and Magnesium 1.4 (1.5-2.5)
- Pet has been eating and drinking normally, normal activity level, etc.
- 10YO Heeler X FS wt =30#
- Chronic diarrhea (suspected small intestinal) since at least January 2015. Weight loss of 4lbs in that time. Pet is also hypoalbuminemic.
- Sonographically normal liver, adrenals and kidneys.
- CBC-WNL, U/A: NSFs, Chem Panel- All WNL except: Albumin 2.2 (2.7-4.4) and Magnesium 1.4 (1.5-2.5)
- Pet has been eating and drinking normally, normal activity level, etc.
- 21 day treatment trial of metronidazole 10mg/kg and Fortiflora produced little to no improvement in stool quality. Panacur trial also produced no improvement.
- FNA of Splenic nodule and an enlarged jejunal ln.
- FNA cytology of enlarged LN and Splenic nodule read out by Dr. C. Barton:
“From the cytology, one would presume that the splenic nodules and enlarged lymph node sampled represent lymphoid hyperplasia, probably in response to a relatively low-grade and chronic antigenic stimulation. The low albumin and the low magnesium are very worrisome, with the magnesium perhaps due to decreased absorption through the jejunum and ileum; those parts of the small bowel are the primary sites for magnesium absorption from the bowel, and there is no suggestion in the history of a syndrome that would result in magnesium wasting. One would be concerned about significant bowel disease that will likely require bowel biopsies to diagnose, such as severe inflammatory bowel disease or lymphangiectasia.”
My question: Can the intestines (stomach, small and large bowel) be sonographically normal and yet there be significant GI disease resulting in Alb and Mg losses associated with PLE?
Comments
Yes if liver is normal and no
Yes if liver is normal and no significant proteinuria then PLE would be the culprit and on occasion look normal but you can give a few tbsp of corn oil and a fatty meal an hour before th escan and use linear hi resolution to find the mucosal striations. I would re fna the splenic nodule and Ln if not responding to ABs as hyperplasia now may be lsa later.
Got it! I will offer to the
Got it! I will offer to the client a repeat the scan after a corn oil and fatty meal. Thanks for this suggestion. Owner’s may go forward with intestinal biopsies. If so I will update here.
Yes if liver is normal and no
Yes if liver is normal and no significant proteinuria then PLE would be the culprit and on occasion look normal but you can give a few tbsp of corn oil and a fatty meal an hour before th escan and use linear hi resolution to find the mucosal striations. I would re fna the splenic nodule and Ln if not responding to ABs as hyperplasia now may be lsa later.
Got it! I will offer to the
Got it! I will offer to the client a repeat the scan after a corn oil and fatty meal. Thanks for this suggestion. Owner’s may go forward with intestinal biopsies. If so I will update here.